Necrotizing Enterocolitis in Infants Born to Women with Severe Early Preeclampsia and Absent End-Diastolic Umbilical Artery Doppler Flow Velocity Waveforms

Gert F. Kirsten; Netta van Zyl; Mariette Smith; Hein Odendaal

doi:10.1055/s-2007-993877

American Journal of Perinatology, Table of Contents

Am J Perinatol 1999; 16(6): 309-314
DOI: 10.1055/s-2007-993877

ORIGINAL ARTICLE

Necrotizing Enterocolitis in Infants Born to Women with Severe Early Preeclampsia and Absent End-Diastolic Umbilical Artery Doppler Flow Velocity Waveforms

Gert F. Kirsten¹ , Netta van Zyl¹ , Mariette Smith² , Hein Odendaal¹

¹Departments of Paediatrics and Obstetrics, Tygerberg Hospital and the University of Stellenbosch and the MRC Unit for Perinatal Mortality, Cape South Africa.
²Departments of Obstetrics, Tygerberg Hospital and the University of Stellenbosch and the MRC Unit for Perinatal Mortality, Cape South Africa.

Abstract

ABSTRACT

The aim of this study was to determine the prevalence of necrotizing enterocolitis (NEC) in infants born to a homogeneous group of women with severe preeclampsia before 34 weeks' gestation and who had absent end-diastolic umbilical artery Doppler flow (AEDF) or normal umbilical Doppler flow velocities (NUFV). A total of 242 infants were entered into the study. The mean birth weight was 1260.5 g (SD = 339) and the mean gestational age 30.5 weeks (SD = 2.0). Sixty-eight (28%) infants had AEDF, 43 (18%) had umbilical artery Doppler flow velocities between the 95th and 99th per-centile, and 131 (54%) had NUFV. Forty-one (18%) infants developed NEC, of whom 20 (8%) developed definite and advanced NEC (grade 2 and 3). Of these, 16 (80%) had grade 2 and 4 (20%) had grade 3. Twenty-one (8%) infants developed suspected NEC (grade 1). The mean onset of grade 1 NEC (7.2 days) occurred significantly earlier than in those with grades 2 and 3 NEC (18.7 and 23.3 days, respectively). Of the 21 infants with grade 1 NEC, 10 (48%) had AEDF and 9 (43%) had NUFV. None of the infants with grades 2 or 3 NEC had AEDF. We conclude that although chronically hypoxemic fetuses born to women with severe early onset preeclampsia and AEDF respond by redistributing blood flow to vital organs and away from the gut; the intestinal compromise is of insufficient magnitude to induce intestinal necrosis or NEC. Enteral feeding, however, should be introduced cautiously in infants with AEDF, as so-called suspected NEC developed significantly more often in these infants.

Keywords

Necrotizing enterocolitis - absent end-diastolic umbilical artery Doppler flow velocity waveforms - preeclampsia

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